Milakovic Milica, Gooderham Melinda J
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Skin Centre for Dermatology, Peterborough, ON, K9J 5K2, Canada.
Psoriasis (Auckl). 2021 Mar 17;11:21-29. doi: 10.2147/PTT.S303634. eCollection 2021.
Psoriasis is a chronic immune-mediated inflammatory disorder. Phosphodiesterase-4 (PDE-4) is an enzyme that mediates inflammatory responses and plays a role in psoriasis pathogenesis. PDE-4 degrades its substrate cyclic adenosine monophosphate (cAMP) to adenosine monophosphate (AMP), which subsequently leads to the production of pro-inflammatory mediators. Inhibitors of PDE-4 work by blocking the degradation of cAMP, which leads to a reduction in inflammation. Apremilast is the only approved oral PDE-4 inhibitor for the treatment of psoriasis. While it is effective for some patients, it may be limited by adverse effects in others. A topical PDE-4 inhibitor, roflumilast, is being investigated in psoriasis and showing promising results. Crisaborole, a topical PDE-4 inhibitor approved for use in atopic dermatitis, has also been investigated in psoriasis. This is an updated comprehensive review to summarize the currently available evidence for the PDE-4 inhibitors apremilast, roflumilast and crisaborole in the treatment of psoriasis, with a focus on data from randomized clinical trials.
银屑病是一种慢性免疫介导的炎症性疾病。磷酸二酯酶-4（PDE-4）是一种介导炎症反应并在银屑病发病机制中起作用的酶。PDE-4将其底物环磷酸腺苷（cAMP）降解为单磷酸腺苷（AMP），随后导致促炎介质的产生。PDE-4抑制剂通过阻断cAMP的降解起作用，从而减轻炎症。阿普米司特是唯一获批用于治疗银屑病的口服PDE-4抑制剂。虽然它对一些患者有效，但对另一些患者可能会受到不良反应的限制。一种外用PDE-4抑制剂罗氟司特正在银屑病治疗中进行研究，并显示出有前景的结果。克立硼罗是一种获批用于特应性皮炎的外用PDE-4抑制剂，也已在银屑病治疗中进行了研究。这是一篇更新的综述，旨在总结目前关于PDE-4抑制剂阿普米司特、罗氟司特和克立硼罗治疗银屑病的现有证据，重点关注随机临床试验的数据。
